title: MRI as an alternative to CT-guided biopsy of adrenal masses in patients with lung cancer.
abstract: BACKGROUND
  This study was performed to assess chemical shift magnetic resonance imaging (CSMRI) for characterizing adrenal masses in patients with lung cancer, and to compare charges associated with two algorithms for assessing adrenal masses in these patients.
  
  
  METHODS
  Forty-two patients with lung cancer underwent both CSMRI (using in-phase and opposed-phase gradient echo images) and computed tomography-guided percutaneous biopsy of adrenal masses. Adrenal-to-spleen signal intensity ratios on the opposed-phase images were correlated with histopathologic results. The normalized charges for two algorithms were compared. In algorithm A, computed tomography-guided biopsy is used first to evaluate an adrenal mass; in algorithm B, CSMRI is used first, followed by computed tomography-guided biopsy only if CSMRI findings are not diagnostic of adenoma.
  
  
  RESULTS
  Biopsy showed 24 (57%) adrenal adenomas and 18 (43%) metastases. Chemical shift magnetic resonance imaging was 96% sensitive for adenoma and 100% specific. The average normalized charges associated with algorithm A were $1,905 per patient versus $1,890 with algorithm B.
  
  
  CONCLUSIONS
  Initial use of CSMRI in evaluating an adrenal mass in lung cancer patients can obviate biopsy in 55% of patients, and its charges are similar to those for performing computed tomography-guided biopsy in all patients.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. schwartl@mskcc.org
authors.forename: L H
authors.initials: LH
authors.lastname: Schwartz
authors.forename: M S
authors.initials: MS
authors.lastname: Ginsberg
authors.forename: M E
authors.initials: ME
authors.lastname: Burt
authors.forename: K T
authors.initials: KT
authors.lastname: Brown
authors.forename: G I
authors.initials: GI
authors.lastname: Getrajdman
authors.forename: D M
authors.initials: DM
authors.lastname: Panicek
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary; D000236:Adenoma / Q000175:diagnosis*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy / Q000191:economics / Q000379:methods; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed